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The Biden-Harris Administration's Statement of Drug Policy Priorities

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The Biden-Harris Administration's Statement of Drug Policy Priorities EXECUTIVE OFFICE OF THE PRESIDENT OFFICE OF NATIONAL DRUG CONTROL POLICY Washington, DC 20503 The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One The overdose and addiction crisis has taken a heartbreaking toll on far too many Americans and their families. Since 2015, overdose death numbers have risen 35 percent, reaching a historic high of 70,630 deaths in 2019.1 This is a greater rate of increase than for any other type of injury death in the United States.2 Though illicitly manufactured fentanyl and synthetic opioids other than methadone (SOOTM) have been the primary driver behind the increase, overdose deaths involving cocaine and other psychostimulants, like methamphetamine,3 have also risen in recent years, particularly in combination with SOOTM. New data suggest that COVID-19 has exacerbated the epidemic,4, 5 and increases in overdose mortality6 have underscored systemic inequities in our nation’s approach to criminal justice and prevention, treatment, and recovery. President Biden has made clear that addressing the overdose and addiction epidemic is an urgent priority for his administration. In March, the President signed into law the American Rescue Plan, which appropriated nearly $4 billion to enable the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration to expand access to vital behavioral health services. President Biden has also said that people should not be incarcerated for drug use but should be offered treatment instead. The President has also emphasized the need to eradicate racial, gender, and economic inequities that currently exist in the criminal justice system. These drug policy priorities—statutorily due to Congress by April 1st of an inaugural year—take a bold approach to reducing overdoses and saving lives.7 The priorities provide guideposts to ensure that the federal government promotes evidence-based public health and public safety interventions. The priorities also emphasize several cross-cutting facets of the epidemic, namely by focusing on ensuring racial equity in drug policy and promoting harm-reduction efforts. The priorities are: • Expanding access to evidence-based treatment; • Advancing racial equity issues in our approach to drug policy; • Enhancing evidence-based harm reduction efforts; • Supporting evidence-based prevention efforts to reduce youth substance use; • Reducing the supply of illicit substances; • Advancing recovery-ready workplaces and expanding the addiction workforce; and • Expanding access to recovery support services. ONDCP will work closely with other White House components, agencies and Congress to meet these priorities.8 ONDCP will also work closely with State, local, and Tribal governments, 1 ONDCP 2021 The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One especially around efforts to ensure that opioid lawsuit settlement funds are used on programs that strengthen the nation’s approach to addiction. Priority 1: Expanding access to evidence-based treatment President Biden is committed to achieving universal coverage which will help provide more people with substance use disorders with the care they need. For far too long, people with substance use disorders have faced stigma and other barriers inside and outside of health care and addiction services.9 Additionally, addiction treatment and mainstream health care have existed in two separate systems. As President Biden has emphasized, ensuring Americans have access to affordable, high-quality health care and achieving universal health care are the most crucial steps toward addressing substance use disorders. Continued enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA)10 is essential to integrating treatment for substance use disorder into mainstream health care and improving the quality of care. Provider shortages,11,12 the cost of health care services,13 reimbursement,14,15 and other barriers to treatment16 combine to make access to quality treatment out of reach for too many.17 American researchers, health care systems, and payers need to develop, scale up, and support a broader array of evidence-based treatment and recovery supports, including services such as housing. A lack of adequate support from leadership and for reimbursement can dissuade providers from entering an area of practice.18,19 Moreover, experts believe that even with greater support, regulatory oversight of providers and prescribers of medications for opioid use disorder (MOUD)20,21,22 and attitudes toward individuals with substance use disorders23 may cause health care providers to be reluctant to provide services to those in need.24,25 The Biden-Harris Administration will carefully examine this complex legal and regulatory web, decide which changes are critical, and put in place or recommend the needed regulatory or legislative changes. In the first year, the Biden-Harris Administration will work through ONDCP to coordinate with other White House components and the interagency to: • Evaluate progress made since the 2016 Mental Health and Substance Use Parity Task Force issued its recommendations26 and identify additional steps that need to be taken to complete these recommendations; • Review policies relating to methadone treatment and develop recommendations to modernize them; • Remove unnecessary barriers to prescribing buprenorphine and identify opportunities to expand low-barrier treatment services; • Develop and establish a working group with health care insurers and employers to promote full implementation of the MHPAEA27 to eliminate discriminatory barriers to mental health and substance use disorder services; • Urge extension of the Opioid Public Health Emergency declaration and identify actions that can be taken under public health authorities to expand access to care; • Evaluate and explore making permanent the emergency provisions implemented during the COVID-19 pandemic concerning MOUD authorizations, including allowing providers to begin treating patients with MOUD by telehealth without first requiring an 2 ONDCP 2021 The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One in-person evaluation, as well as evaluating and ensuring the continuation of Medicaid and Medicare reimbursements for these telehealth services; • Identify and address policy barriers related to contingency management interventions (motivational incentives) for stimulant use disorder; • Explore reimbursement for motivational incentives and digital treatment for addiction, especially stimulant use disorder; • Expand access to evidence-based treatment for incarcerated individuals by working with Congress and appropriate Departments and agencies; • Publish final rules this year regarding telemedicine special registration and methadone treatment vans; and • Explore, identify barriers, and establish policy to help pregnant women with substance use disorder obtain prenatal care and addiction treatment without fear of child removal. Priority 2: Advancing racial equity in our approach to drug policy There is a clear and discernable need to take steps to advance racial equity issues28 resulting from current drug policy. President Biden has emphasized the need to eradicate racial inequities in the criminal justice system and has stated that people should not be incarcerated for drug use but should be offered treatment instead. Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, directs agencies to pursue a comprehensive approach to advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.29 Such inequalities manifest in disparate access to care, differential treatment, and poorer health outcomes. For many people with substance use disorders, access to care in the United States is inadequate, but for Black, Indigenous, and People of Color (BIPOC), the situation is worse. A recent study showed that Black individuals generally entered addiction treatment 4-5 years later than White individuals and this effect remained when controlling for socio-economic status.30 In Latino communities, those who need treatment for substance use disorder were less likely to access care than non-Latino individuals.31 This discrepancy in treatment access is important to address at a time when rates of overdoses are increasing for some communities of color.32 In the first year, the Biden-Harris Administration will work through ONDCP to coordinate with other White House components and the interagency to: • Identify data gaps related to drug policy to target unmet needs in diverse communities, in collaboration with the Equitable Data Working Group established by Executive Order 13985; • Establish a research agenda to meet the needs of historically underserved communities; • Establish an interagency working group to agree on specific policy priorities for criminal justice reform; • Develop a drug budget that includes an accounting and analysis of how federal dollars meet the needs of diverse populations and shape drug budget recommendations to target resources to address equity issues; 3 ONDCP 2021 The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One • Direct agencies to begin collecting budget data that is thoroughly disaggregated by demographic category where this information is not available; • Identify culturally
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